Neonatal brucellosis: A case report.

Although brucellosis is not uncommon in Saudi Arabia, neonatal brucellosis has been infrequently reported. In this case of neonatal brucellosis, Brucella abortus was isolated by blood culture from both the mother and the neonate. Serology was positive only in the mother.

Changing epidemiology of tuberculosis detected by an 8-year retrospective laboratory study in a tertiary teaching hospital in central Saudi Arabia.

OBJECTIVE: To study the laboratory diagnosis of tuberculosis (TB), and relate the findings to its epidemiology in Central Saudi Arabia. METHODS: This retrospective study was carried out at the Department of Pathology/Microbiology, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between January 2003 and December 2010. Data were retrieved from the hospital information system on laboratory findings. After adjustment, 9,405 specimens were studied. The specimens were stained by Ziehl-Neelsen (ZN), auramine-rhodamine, and cultured in Bactec alert 960, and Lowenstein-Jensen media. Mycobacterium tuberculosis (M. tuberculosis) complex and non-tuberculous mycobacteria were differentiated by ProbTec system and p-nitrobenzoate medium. The BACTEC MGIT 960 SIRE kit was used for susceptibility testing. RESULTS: A total of 568 (6%) specimens grew M. tuberculosis complex, and 87% were from Saudis with an incidence rate of 55.6/100,000 of TB. Time to positive growth in the Bactec liquid medium was directly related to the acid fast bacilli smear load. Most of the positive patients were from the 18-35 years age group. The percentage of multidrug resistance was 0.7%. CONCLUSION: Most patients (87%) were Saudis showing an incident rate of 55.6/100,000. An increase of TB cases was noticed in the 18-35 age group. Resistance to isoniazid was 10.6%, 1% to Rifampicin, 2-8% to Ethambutol, and streptomycin was 6%.

National surveillance of antimicrobial resistance among Gram-positive bacteria in Saudi Arabia.

BACKGROUND: Antimicrobial-resistant Gram-positive bacteria are important causes of serious infections. METHODS: Between January and December 2009, we examined clinical Gram-positive isolates from 24 hospitals across Saudi Arabia. RESULTS: Among the 13750 isolates, Staphylococcus aureus (62.3%) was the commonest, followed by non-group A beta-haemolytic streptococci (14.8%), group A beta-haemolytic streptococci (7.1%), coagulase-negative staphylococci (6.6%), pneumococci (6.0%), and enterococci (3.1%). Resistance rates were high among S. aureus (methicillin-resistant S. aureus: 32%), coagulase-negative staphylococci (oxacillin: 63%) and pneumococci (penicillin G: 33%; erythromycin: 26%; ceftriaxone: 11%); low among enterococci (vancomycin: 1%) and among beta-haemolytic streptococci. Resistance rates varied between regions, but comparison was complicated by differences in antibiotics tested. Many relevant antibiotics were tested against few isolates (e.g. ampicillin, vancomycin, and high-level gentamicin versus enterococci) while unhelpful tests were widely performed (e.g. cefotaxime, ceftriaxone, and imipenem versus staphylococci. CONCLUSION: Resistance is widespread in staphylococci and pneumococci, but not enterococci and beta-haemolytic streptococci in Saudi Arabia. Rationalization of antibiotic panels tested is urgently needed.

Antimicrobial resistance among non-fermenting Gram-negative bacteria in Saudi Arabia.

OBJECTIVES: Non-fermentative Gram-negative bacilli (non-fermenters) can cause serious healthcare-associated infections and are often resistant to multiple antibiotics. We examined resistance rates among these bacteria from different regions of Saudi Arabia. METHODS: A cross-sectional study between January and December 2009 examined 8908 clinical non-fermenters from 24 hospitals across Saudi Arabia. Susceptibility testing was monitored to ensure compliance with CLSI guidelines, but the antibiotics tested were at the hospitals' discretion. RESULTS: Out of the 8908 non-fermenters, most were Pseudomonas aeruginosa (72.9%), followed by Acinetobacter baumannii (25.3%) and Stenotrophomonas maltophilia (1.8%). Resistance rates among P. aeruginosa were: polymyxin B, 2.2%; imipenem, 15.9%; ciprofloxacin, 22.0%; amikacin, 22.9%; and gentamicin, 31.2%. Resistance rates among A. baumannii were: imipenem, 5.4%; polymyxin B, 13.2%; ciprofloxacin, 64.0%; trimethoprim/sulfamethoxazole, 73.8%; amikacin, 76.9%; and gentamicin, 77.8%. Resistance rates among S. maltophilia were: polymyxin B, 6.9%; trimethoprim/sulfamethoxazole, 20.5%; and ciprofloxacin, 38.9%. There was major variation in resistance rates between geographical regions. CONCLUSIONS: Resistance rates among non-fermenters were high in Saudi Arabia and were variable among regions.

Antimicrobial activity of tigecycline against bacterial isolates from intensive care units in a teaching hospital in Central Saudi Arabia.

OBJECTIVE: To test the activity of tigecycline against bacterial isolates including multi-drug resistant (MDR) gram negative and gram positive organisms from intensive care patients. METHODS: Clinically significant gram positive and MDR gram negative isolates from specimens of patients in the intensive care units of King Khalid University Hospital (KKUH), Riyadh, Kingdom of Saudi Arbia between November 1, 2006 and December 31, 2008 were tested against tigecycline by disc diffusion (DD) method. In some isolates, the minimal inhibitory concentration was carried out by E-test method. Some of the gram negative isolates, and gram positive isolates were tested using both methods. The study was approved by the hospital ethics committee. RESULTS: All the 83 gram positive organisms tested by both DD and E-test were susceptible to tigecycline. Two hundred and fifty-four MDR gram negative isolates were tested for susceptibility to tigecycline. Of these 176 tested by DD, 159 (90%) were susceptible, 6 (3.4%) were resistant, and 11 (6.2%) were intermediately susceptible (data are not the same in table 3). From the 188 isolates tested by E-test, 140 (74.4%) were susceptible, 35 (18.6%) were resistant, and 13 (6.9%) showed intermediate susceptibility. For comparison between the methods, 109 isolates of the MDR gram negative organisms were tested by both E test and DD. The difference between the 2 methods was not significant. CONCLUSION: Tigecycline was active against gram positive and most MDR gram negative isolates from patients in medical and surgical intensive cases in KKUH. There was no significant difference between the DD and E-test methods for susceptibility testing of tigecycline against these isolates.

Bloodstream infections in pediatric patients.

OBJECTIVE: Blood stream infection (BSI) is the leading cause of morbidity and mortality in pediatric patients. This study aims to describe the clinical, microbiological characteristics and outcome of BSI in pediatric patients. METHODS: We collected the clinical data from all pediatric patients with positive blood cultures. We identified all isolates from these patients from January 2004 to December 2004 at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia, and determined antimicrobial susceptibilities by MicroScan Walk Away 96 (Dade Behring Inc., West Sacramento, CA95691, USA). RESULTS: Two hundred and twenty pediatric patients had BSI, of whom 147 (67%) were males and 71 (32.2%) were from intensive care units (ICUs). Two hundred and ten (95.4%) had single blood culture isolate. One hundred and seventy-three (78.6%) of the isolates were Gram positive bacteria and included the following: Staphylococcus epidermidis (55.4%), Staphylococcus aureus (9.5%) of which 14% were methicillin resistant, Streptococcus pneumoniae (S. pneumoniae) (4.5%), 40% of which were resistant to penicillin and Enterococcus faecalis (4%). Gram negative bacteria were 44 (20%) and included Escherichia coli and Klebsiella pneumoniae (K.pneumoniae) (3.6% each). Three isolates (1.3%) were Candida glabrata. None of the Gram positive isolates were vancomycin resistant. Three K.pneumoniae and one Pseudomonas spp. isolates were multiresistant. One hundred and ninety-four (88%) of BSI isolates were hospital acquired. Fever was the most common presentation of pediatric patients (26%) with positive blood culture with no apparent focus of infection. Respiratory tract infections 26 (12%) were the next most common. We seen sepsis in (7.7%) children between 8 days and 6 months of age. Bone and joint infections, cardiac, renal, gastrointestinal diseases, malignancy and surgical cases were other associated clinical diagnoses of BSI in pediatric patients. Patients with immuno- suppressive disorders with BSI had isolates such as Salmonella spp., S. pneumoniae and Pseudomonas spp. Overall mortality was 13 (6%) (p<0.005) and those patients had underlying serious medical conditions with associated risk factors such as prolonged hospital stay, intensive care unit (ICU) admission, indwelling catheterization, mechanical ventilation and prior antimicrobial use. CONCLUSION: Bloodstream infection is an important cause of morbidity and mortality in pediatric patients. Risk factors for hospital acquired infection include: prematurity, prolonged hospitalization, ICU admission, indwelling catheterization, mechanical ventilation and prior antimicrobial therapy.

Isolation of coryneform bacteria from blood cultures of patients at a University Hospital in Saudi Arabia.

OBJECTIVE: Coryneform bacteria have been increasingly recognized as opportunistic pathogens in recent years. The aim of this study is to identify and determine the antimicrobial susceptibility of coryneform bacteria isolated from blood cultures of patients seen at King Khalid University Hospital (KKUH), Riyadh, Kingdom of Saudi Arabia and review the literature. METHODS: All coryneform bacteria isolated from blood culture specimens between January 2001 and March 2003 were prospectively identified by API Coryne System (BioMerieux, France). Clinical data were collected from each patient's medical record. Antimicrobial susceptibility to 16 antimicrobial agents were determined by minimum inhibitory concentration (MIC) using E-test (AB Biodisk, Solna, Sweden). RESULTS: Out of 50 coryneform bacteria isolated, 19 different species were identified. Corynebacterium propinquum was the most common species 6/50 (12%) followed by Corynebacterium auris 5/50 (10%), Corynebacterium afermentans, Corynebacterium striatum, Dermabacter hominis, Brevibacterium, and Arthrobacter species 4/50 (8%) each. Underlying chest diseases were common among the patients 11/50 (22%), followed by different surgeries 10/50 (20%). Of all, 12/50 (24%) patients were from different intensive care units (ICUs), 36/50 (72%) had either vascular, urinary or respiratory intubation. Three patients in ICUs died, one was an elderly patient with gastrointestinal bleeding and 2 teenagers (one had tracheoesophageal fistula and the other was post-arrest road traffic accident patient). Vancomycin was the most active antimicrobial agent against all coryneform species. The majority had MIC <1 ug/ml. For most isolates, the MIC90s of erythromycin, clindamycin, and ciprofloxacin were above the break points. Corynebacterium striatum was the only isolate susceptible to ampicillin. CONCLUSION: This study revealed that coryneform bacteria are increasingly being recognized as a cause of serious infections in immunocompromised patients. We recommend identification and susceptibility testing of predominant isolates of coryneform bacteria from different clinical sites of seriously ill patients to select the antimicrobial agent necessary for clinical intervention.

Enterococcal bacteremia in a teaching hospital in the Central region of Saudi Arabia.

OBJECTIVE: To study enterococcal blood stream infection including the different species isolated, their antibiotic resistance associated risk factors and outcome of treatment. METHODS: A retrospective and prospective study was carried out over a 12 month period between June 2001 and May 2002 in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. Sixty episodes of enterococcal bacteremia with clinical significance detected in adults and neonates were included. Statistical analysis of the epidemiological characteristic, etiologic risk factors and mortality were determined. RESULTS: Fifty-four (90%) of the episodes were hospital acquired. Fifty-five percent of patients were elderly males and 20% were neonates. Patients usually have severe underlying diseases (57%) and the mortality rate was 28%. The estimated duration of hospital stay after acquiring the Enterococcal bacteremia was 40 days. The source of bacteremia remained undetermined in 72% of the episodes. Gastrointestinal tract, urinary tract and intravascular catheter were the most frequently recognized associated sites of infection. Thirty-three patients (55%) had previously received antimicrobial agents (mainly cephalosporins). In this study, intravascular catheter (p=0.0002), urinary catheter (p=0.00001), mechanical ventilation (p=0.002), previous surgery (digestive tract surgery (p=0.01) and prior stay in an intensive care unit (p=0.03) were the factors associated with Enterococcal bacteremia and mortality. CONCLUSION: Efforts to reduce the occurrence of enterococcal bacteremia should be focused on appropriate use of cephalosporins and external devices.

Hemophilus influenzae serotype-b meningitis in an adult immunocompetent patient.

We present a case of meningitis caused by Hemophilus influenzae type b in an immunocompetent 41-year-old Saudi lady. The patient was successfully treated with Ceftriaxone for 10 days. A review of Hemophilus influenzae meningitis in adults and the impact of conjugated vaccine on the epidemiology of the disease are given.

Hemophilus influenzae serotype-b meningitis in an adult immunocompetent patient.

We present a case of meningitis caused by Hemophilus influenzae type-b in an immunocompetent 41-year-old Saudi lady. The patient was successfully treated with Ceftriaxone for 10 days. A review of Hemophilus influenzae meningitis in adults and the impact of conjugated vaccine on the epidemiology of the disease are given.

Prevalence of H.influenzae biotypes and their clinical significance in a University Hospital.

OBJECTIVE: Hemophilus influenzae is an important pathogen that is responsible for invasive and non-invasive infections in both children and adults. This study aims to assess the relationship of biotypes to the sites of infection, serotypes, antimicrobial susceptibility, beta-lactamase production and age. METHODS: A total of 200 isolates of H.influenzae were obtained from clinical specimens over a period of 12 months from January 2001 through to January 2002 from King Abdul-Aziz University Hospital, Riyadh, Kingdom of Saudi Arabia. RESULTS: Most of the strains were non-typable and were isolated from patients with non-invasive infections. The typable isolates from invasive infections mostly serotype b were isolated from blood, cerebrospinal fluid and hip joint aspirate. Biotype II accounted for 37% of the isolates followed by biotypes III and I (29.5% and 23%). The remaining 10.5% were made up of biotypes IV, V, VI and VII. A significantly high resistance to cotrimoxazole (33.5%) and ampicillin (19%) was observed. Two point five percent of the isolates were resistant to chloramphenicol. All the isolates resistant to ampicillin were beta-lactamase producers and susceptible to cefuroxime, ceftriaxone, ciprofloxacin and rifampicin. CONCLUSION: This study revealed that biotypes II and III are the predominant biotypes of H.influenzae found in non-invasive infections. There is an apparent relationship between biotype and site of infection which could be useful as an epidemiological marker.